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Fill in the blаnks belоw by using this Wоrd Bаnk except certаin questiоns where indicated (some words will not be used): A adequate APC C charges contingent cost established protocols extensive fee schedule fully G higher J1 lower MS-DRG N new technology next gen procedures partially profitable prospective RBRVS retrospective S T V 1. Which reimbursement methodologies are used in OPPS? There are three reimbursement methodologies used in OPPS: [BLANK-1] payment (case-rate), [BLANK-2] payment, and reasonable [BLANK-3] payment. 2. Which payment status indicator is used to identify services that are packaged? Status indicator [BLANK-4] is used for packaged services. 3. Which payment status indicators are used to identify services that are paid using a reasonable cost-based methodology? a. F, T, S b. H, P, L c. J1, L, M d. F, H, L Based on the choices given, enter a. or b. or c. or d. [BLANK-5] 4. Which of the following payment status indicators is the highest ranked SI and causes all other services to be packaged on a claim? a. T b. S c. J1 d. J2 Based on the choices given, enter a. or b. or c. or d. [BLANK-6] 5. Which classification system is used in OPPS to combine procedures or services that are clinically comparable and have similar resource use together into groups? The [BLANK-7] system is used to group procedures and services together. 6. Which type of service includes an APC per diem methodology that includes payment for all services provided on a single day of service under OPPS? a. Clinic visits b. Partial hospitalization c. Emergency department visits d. Same day surgery Based on the choices given, enter a. or b. or c. or d. [BLANK-8] 7. Which type of APCs did CMS establish in order to support access for Medicare beneficiaries to receive new and innovative drugs, biologicals, and devices in the hospital outpatient setting? [BLANK-9] APCs allow for new and innovative drugs, biologicals, and devices to quickly enter into the OPPS so that Medicare beneficiaries have access to them. 8. Comprehensive APCs (C-APCs) have status indicators J1 and J2. They are CMS’ first step in moving OPPS from a [BLANK-10] packaged system to a [BLANK-11] packaged system 9. What is the purpose of the cancer hospital adjustment provision? Provide [BLANK-12] reimbursement to cancer hospitals that primarily have only one service line—cancer treatment. 10. Why do sole-community hospitals receive a rural hospital adjustment under OPPS? Analysis showed that sole-community hospitals’ cost is 7.1 percent [BLANK-13] than other hospitals paid under OPPS. Therefore, CMS adjusted their payment by that percentage.
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